1. Workgroup Three (The Orange Group) Vaccine Supply Vaccine Distribution Vaccine Financing –Key issues Barriers Needs Solutions

2. Vaccine Supply & Distribution: Barriers Unpredictable production Multiple products and formulations Importance of timing of vaccine availability Inherent challenge in balancing supply and demand/utilization

3. Vaccine Supply & Distribution: Barriers Information –Not very coordinated right now Who gets what and when? Unclear how influenza distribution in the public sector will work this year – first year using the centralized system –How does influenza vaccine travel through the distribution network? Byzantine path from manufacturer to implementation points

4. Vaccine Supply & Distribution: Needs Improved uptake and demand –Minimize waste of vaccine Change in providers mindsets –Why do all doses have to arrive in September and October? –Opposition to non-traditional sites Inconsistent with push to extend the vaccination season and knock down access barriers Change in publics mindsets –Need to be vaccinated annually and vaccinated throughout the season, irrespective of risk profile

5. Vaccine Supply & Distribution: Solutions Communications –Multiple levels Better communications between and amongst stakeholders about vaccine yield and production –Need information for contingency plans –Improves consistency and combats rumors and misperceptions –Make sure that all the information trickles down to the levels of implementation Better communications to providers and the public –Helps combat complacency –What are the message maps that work that drive demand? Identifying those will be helpful

6. Vaccine Supply & Distribution: Solutions Improve Flu Finder Local access to SNS data –Granularity of the data Improved operational support to implement the expanded recommendation Partnerships Identifying and disseminating best practice models –Model private provider practices –Models of what works in communities

7. Vaccine Supply & Distribution: Lingering Questions/Issues Does public health want to take on the role of community coordinator? Who will take charge of identifying, documenting, evaluating, warehousing, and disseminating best practices?

8. Vaccine Financing: Barriers –Accountability for vaccine is important challenge Lots of suggestions about points of access but more involved than just getting vaccine doses to those places –Full access to vaccines is expensive –Gaps exist for underinsured children These situations put health departments in ethically tense situations

9. Vaccine Financing: Needs Financing of expanded recommendations –Adequate, timely federal and state discretionary funds –Managed care / private insurance funds Adequate administration fee State appropriated funds Local funding support Federal Section 317 program funds

10. Vaccine Financing: Solutions Work with state Medicaid agencies to increase the administration fee toward the allowable amount Continue the dialogue on vaccine financing –NVAC –AAP –Flu Summit

11. Vaccine Financing: Solutions Make influenza vaccination a standard of care issue Mobilization of state and local resources –Focus on resources vs deficits The discussion should not be about how much money is being spent on implementing influenza recommendations, it should be on how it is being spent

12. Final Thoughts Many have repeatedly stated in different ways that implementation will be local If we really want to meet the challenges of implementing the expanded recommendations, then lets recognize the value of a robust public health infrastructure and support it accordingly The rubber meets the road at the local level, and there is not a lot of tread on the tires

13. Final Thoughts Theres a whole new world of stakeholders out there Renewed vigor with Federal/State health officials Renewed vigor with non-traditional partners Renewed vigor with medical care providers/institutions Renewed vigor with social service agencies – reaching the hard-to-reach (Re)new relationship with business community Renewed vigor with schools (Re)new vigor with faith communities Renewed emphasis on communications

14. Overarching Barriers –20 th century systems, thinking, and practices attempting to implement 21 st century recommendations Needs –Thorough review of current systems and practices – desperate need of updating Solutions –Transformation of public health and health care systems (no tinkering around)